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NO, A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 9 Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> ��11 l <br /> Client L [le51V C'I�C�J /�(E�.(�'ti �f�JC� Phone <br /> �,./ -A.moo <br /> Address? C'c % 7 l 4 CC to: <br /> lA �- � zip � � ��• <br /> �Jr <br /> Signature of person authorizing work <br /> under terms stated below' " ., B'f- <br /> 'Net 30 days. All accounts past due will be subject to interest c rges of 1.5% per month. <br /> 'Hazardous materials are the property of the client. The client is responsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECT ID No ANALYSIS <br /> !/L) / <br /> lL' j 771�� ' �� of <br /> Con- <br /> SAMPL o BY: (sigmp f2�: tain. <br /> ers �Ai REMARKS <br /> sample <br /> 'ype Sample Location <br /> Date Time Grab Comp. <br /> a �_ � _ <br /> R V <br /> f`'.� <br /> lY r 1C <br /> Relinquished by(s}g 'ture): 9at7 Time Received by(signature):,,—) Date Time <br /> Relinquish by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />